BREASTFEEDING MEDICINE

Volume 8, Number 2, 2013

ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2012.0119

Impact of a Breastfeeding-Friendly Workplace

on an Employed Mother’s Intention to Continue
Breastfeeding After Returning to Work

Su-Ying Tsai

Abstract

Background: Ever-increasing populations of women in their childbearing years are choosing to become em-
ployed. Breastfeeding provides unique health advantages to both the infant and mother. A breastfeeding-
friendly workplace might be an important factor for predicting breastfeeding rates among working women. To
explore the impact of breastfeeding-friendly support on the intention of working mothers to continue breast-
feeding, we conducted a survey at a female labor-intensive electronics manufacturer in Taiwan.
Subjects and Methods: A structured questionnaire survey was administered to 715 working mothers employed
in an electronics manufacturing plant in Tainan Science Park in Southern Taiwan. Questionnaire content in-
cluded female employee demographics, employment characteristics, continued breastfeeding behavior after
returning to work, access to lactation rooms, and employee perception of the breastfeeding policy and support
when raising their most recently born child.
Results: A higher education level (odds ratio [OR] = 2.66), lower work load (8 work hours/day) (OR = 2.66),
lactation room with dedicated space (OR = 2.38), use of breast pumping breaks (OR = 61.6), and encouragement
from colleagues (OR = 2.78) and supervisors (OR = 2.44) to use breast pumping breaks were significant predictors
of continued breastfeeding for more than 6 months after returning to work.
Conclusions: The findings of the present study suggest that to encourage and increase the rate of continued
breastfeeding, workplaces should establish dedicated breastfeeding rooms and maintain a comfortable and clean
environment. Furthermore, employers should provide encouragement and support for working mothers to
continue breastfeeding after returning to work.

Introduction dren is a critical element and may increase a mother’s inten-

T he population of women becoming employed during
their childbearing years is growing.1 Although the ben-
efits of breastfeeding to both the infant and mother are well
established, employment is a persistent barrier to continued
breastfeeding.2–5 Lack of break time, inadequate facilities for
pumping and storing milk, lack of resources that promote
breastfeeding, and lack of support from employers and col-
leagues are among the challenges faced by employed mothers
who want to continue breastfeeding by expressing their
milk in the workplace. Breastfeeding provides unique health
advantages to both the infant and mother,6 and thus a
breastfeeding-friendly workplace for the employed mother is
recommended to increase the initiation and duration of
breastfeeding.7–10 In a breastfeeding-friendly workplace/
policy, the provision of lactation rooms and breast pumping
breaks for female employees to express breastmilk for chil-
tion to continue breastfeeding after returning to work. A
population cohort study3 using the Taiwan National Birth
Register database in 2005 revealed a decline in the prevalence
of breastfeeding among employed mothers, and overall only
67.9%, 39.4%, 25.4%, and 12.7% mothers who started breast-
feeding still breastfed their infants at 1, 3, 6, and 12 months
after childbirth, respectively. Another survey of breastfeeding
among employed mothers in Taiwan revealed that only 10.6%
of mothers continued to breastfeed after returning to work.11
Although more and more large companies have accepted the
idea of a breastfeeding-friendly policy and established lacta-
tion rooms and breast pumping breaks in the workplace,12 the
effectiveness for continued breastfeeding among employed
mothers is uncertain.
In the present study, we conducted a survey among
mothers employed in a female labor-intensive electronics
manufacturing company in Taiwan to explore the impact of

Department of Health Management, I-Shou University, Kaohsiung, Taiwan.

210
BREASTFEEDING-FRIENDLY WORKPLACE AND BREASTFEEDING
lactation services, such as time and space to express milk
during the work period, that enable women to continue
breastfeeding. The findings of the present study will contribute
to a better understanding by occupational and environmental
health nurses of the barrier to continued breastfeeding and the
implementation of a breastfeeding-supportive workplace en-
vironment for these employed mothers.
Subjects and Methods
Research setting and subjects
This was a retrospective survey of a breastfeeding-friendly
workplace and intention to continue breastfeeding after re-
turning to work among employed mothers in Taiwan that
was conducted from August 1, 2011 to April 30, 2012. The
research setting was Company C, a large electronics manu-
facturer with high labor-intensive employees in the Tainan
Science Park in Southern Taiwan, which is one of the Taiwan’s
largest areas for electronics manufacturers. This company has
more than 20,000 employees, of whom 45% are female, and
there are 10 manufacturing plants. Each plant provides at
least four lactation rooms for working mothers, with the
largest plant providing 11 lactation rooms for working
mothers.
Company C was selected because, first, it was the one of
several companies that have received funding from the De-
partment of Health to establish lactation rooms in its factories;
hence, it provides lactation rooms and breast pumping breaks
for working mothers. Second, this company has many female
employees. Third, the researcher was able to visit the com-
pany’s plants and record information about the facilities and
the space allocated to the lactation rooms, which can be
classified into two types: breastfeeding rooms with indepen-
dent space versus no dedicated space, only curtain separators;
thus, the influence of different lactation room conditions in the
breastfeeding-friendly environment on continuing breast-
feeding behavior could be evaluated. Moreover, the female
employees were office workers or worked in a clean room (a
room that is maintained virtually free of contaminants, used
in laboratory work and in the production of precision parts for
electronic equipment). Office workers have higher educa-
tional and compensation levels than clean-room workers
and generally work about 8 hours/day, but their positions
encompass specific job responsibilities. By comparison, clean-
room workers work 12-hour shifts. Their jobs are inconve-
nient and inflexible because they must remove and put on
their clean-room suits when leaving and returning to their
workstation. Therefore, we were able to observe the associa-
tion between different working conditions and intention to
continue breastfeeding.
The researcher inquired about the willingness of this
company to participate in the study by first sending an ex-
planatory letter about the research project and then visiting
the employee health management department director of the
company to explain the purpose of the research. After re-
ceiving consent from the employee health management de-
partment, occupational and environmental health nurses
helped distribute and collect the employed mothers’ self-
reported questionnaires. The questionnaire was distributed to
981 female employees who had recently taken maternity leave
between January 2009 and January 2011, as recorded by the
human resources department. Female workers who met the
211
inclusion criteria (maternity leave between January 2009 and
January 2011) could choose to participate in the survey. In
total, 715 valid questionnaires were collected, giving a re-
sponse rate of 72.9%. The study was approved by the In-
stitutional Review Board of I-Shou University, Kaohsiung,
Taiwan.
Assessment instruments and definitions
Questionnaires were used to collect data on female em-
ployees’ demographics, employment characteristics, con-
tinuing breastfeeding behavior after returning to work, access
to lactation room types, and employees’ perception of
breastfeeding-friendly policy and support when raising their
most recently born child. Mean time required to complete the
survey was 15 minutes.
Demographics and employment characteristics. Partici-
pants’ self-reported demographic and employment charac-
teristics were assessed. A demographic inventory was used to
gather data on age, education, husband’s education, and child
information. Level of education was used as a proxy measure
for social class and categorized as follows: (1) high school or
below or (2) college or above.
Employment characteristics were collected, including
worksite (office vs. clean room), shift work (‘‘Did you do shift
work after you returned to work [yes/no]?’’), and work hours
per day (8 hours/day or 9–14 hours/day).
Continuing breastfeeding behavior. This study explored
the predictors of continuing breastfeeding after returning to
work. Working mothers were defined as continuing breast-
feeding if they continued breastfeeding for at least 1 month
after returning to work. Participants were asked, ‘‘Did you
continued to breastfeed after returning to work (yes/no), and
how long did you continue to breastfeed?’’ In Taiwan, most
companies provide only 8 weeks of maternity leave. Hence,
we also assessed the breastfeeding intention during maternity
leave, and participants were asked, ‘‘Did you breastfeed your
baby during maternity leave (yes/no)?’’ Data of self-reported
breastfeeding knowledge were collected in the study, in-
cluding ‘‘Do you think your breastfeeding knowledge and
information is sufficient (sufficient, insufficient, and want or
need more information)?’’
Access to lactation room type and employees’ perception
of breastfeeding-friendly policy and support. In Taiwan, the
law stipulates that employers need to provide 8 weeks of
maternity leave for female employees. The construction and
implementation of a breastfeeding-friendly policy in the
workplace are still new practices in Taiwan. The government
encourages companies or industries to provide breastfeeding
support services, such as breast pumping breaks and lactation
rooms. Employees must bring their own breast pumps. In our
study, all lactation rooms in this company contain a table,
chair, sink, electrical outlets, and refrigerator. Employers
allow working mothers to have two breast pumping breaks
each day with each break lasting no more than 30 minutes.
The researcher visited the plants and recorded observations
about the facilities and space of the lactation rooms, which
were classified into two types: breastfeeding rooms with
dedicated space versus those without dedicated space, only
212 TSAI

curtain separators. Working mothers pumping in rooms Table 1. Characteristics of the Study Sample (n = 715)
without dedicated space meant that working mothers
pumped in a public health center room without independent Variable n %
space, only curtain separators in a space used mainly for other
Age (years)
purposes, such as a public health center for acute trauma or
20–29 171 23.9
injuries. 30–39 533 74.6
To understand an employee’s perception of the breast- ‡ 40 11 1.5
feeding-friendly policies in the workplace, participants re-
Education
sponded to the following questions: ‘‘What kind of lactation High school education and below 203 28.3
room was available in your workplace (independent space/ College and above 512 71.7
without dedicated space)?,’’ ‘‘Were you aware of the pumping
Husband’s education
break policy (yes/no)?,’’ ‘‘Did you ever use the pumping High school and below 184 25.7
break policy after returning to work (yes/no)?,’’ and ‘‘Did you College and above 531 74.3
feel embarrassed if you used breast pumping breaks (yes/
Worksite
no)?’’ Moreover, to assess employees’ perception of work- Clean room 320 44.8
place breastfeeding support, participants were asked, ‘‘After Office 395 55.2
returning to work, did your colleagues, supervisor, and en-
Shift work
vironmental health nurses encourage you to use breast Yes 334 46.7
pumping breaks (yes/no)?’’
Work hours per day
8 119 15.7
Statistical analysis 9–14 596 83.3
This study explored the predictors of continuing breast- Awareness of lactation room
feeding after returning to work. The primary independent Yes 693 98.3
variables of interest were demographics (age, working Access to use and lactation room type
mother’s education level, spouse’s education level), employ- With independent space 608 85.0
ment characteristics (worksite, shift work, work hours per No independent space 107 15.0
day), type of lactation room, breastfeeding-friendly policy Using two breast pumping breaks per day
(awareness of breast pumping breaks, using breast pumping Yes 259 36.2
breaks) and support (encouragement from colleagues, su- No 456 63.8
pervisors, and environment health nurses), and self-reported Breastfeeding during maternity leave
breastfeeding knowledge. The dependent variable in this Never breastfed 80 11.2
study was continuing to breastfeed after returning to work. Ever breastfed 635 88.8
Working mothers were defined as continuing breastfeeding if Continue to breastfeed after returning to work (breastfed for
they continued for at least 1 month after returning to work at least 1 month)
from maternity leave. Hence, working mothers who did not Yes 356 49.8
breastfeed at the beginning of maternity leave and breastfed No 359 50.2
for less than 1 month after returning to work were categorized Continuing breastfeeding duration
as not continuing to breastfeed after returning to work and 1–3 months 69 9.6
were treated as a reference group in the logistic regression 4–6 months 115 16.1
7–12 months 118 16.5
analyses.
> 12 months 54 7.6
All analyses were performed using Statistical Analysis
System (SAS version 6.12; SAS Institute, Cary, NC) software. Self-reported breastfeeding knowledge
Sufficient 384 53.7
Participants’ profiles among working mothers were reported.
Insufficient 331 46.3
The effects of demographics, employment characteristics, and
breastfeeding-friendly policy on continuing to breastfeed
after returning to work were estimated using v2 tests and
their husbands also had a high education level (74.3%). Shift
logistics regression. A p value of < 0.05 was considered sta-
workers comprised 46.7% of the population, and clean-room
tistically significant. To determine whether the independent
workers comprised 44.8%. Only 15.7% of the mothers aver-
variables predict continuing to breastfeed after returning to
aged 8 hours of work/day. Among mothers in the study
work, multiple logistic regression analyses were used to
sample, 85% had access to a lactation room with independent
identify independent variables that were independently as-
space, and 15% had access to a lactation room without dedi-
sociated with continuing to breastfeed for at least 6 months
cated space. Most of the participating subjects (63.8%) did not
after returning to work and continuing to breastfeed for more
take advantage of breast pumping breaks, and 50.2% did
than 6 months after returning to work, respectively. Relative
not continue to breastfeed after returning to work. The
risk was calculated for each independent variable in the lo-
breastfeeding rates after returning to work were 9.6%, 16.1%,
gistic models, and 95% confidence intervals were calculated
16.5%, and 7.6%, respectively, for 1–3 months, 4–6 months,
using maximum likelihood methods.
7–12 months, and more than 12 months, respectively.
Continued breastfeeding behavior after returning to work
Results
was grouped according to demographics, employment
As shown in Table 1, 74.6% of participants were 30–39 characteristics, and breastfeeding-friendly policy, as shown
years old, and 71.7% had college and higher degrees; most of in Table 2. All independent variables were significantly
BREASTFEEDING-FRIENDLY WORKPLACE AND BREASTFEEDING 213

Table 2. Continued Breastfeeding Behavior by Demographic, Employee Characteristics,

and Breastfeeding-Friendly Policy

Continue to breastfeed after returning to work

Variable No (n = 379) £ 6 months (n = 164) > 6 months (n = 172) p value for v2 test

Age (years) 0.0019

< 30 95 (55.6) 52 (30.4) 24 (14.0)
£ 30 264 (48.5) 132 (24.3) 148 (27.2)
Education < 0.0001
College and above 222 (43.4) 142 (27.7) 148 (28.9)
High school and below 137 (67.5) 42 (20.7) 24 (11.8)
Husband’s education 0.0012
College and above 246 (46.3) 143 (26.9) 142 (26.8)
High school and below 113 (61.4) 41 (22.3) 30 (16.3)
Worksite < 0.0001
Clean room 198 (61.9) 67 (20.9) 55 (17.2)
Office 161 (40.8) 117 (29.6) 117 (29.6)
Shift work < 0.0001
Yes 202 (60.5) 77 (23.0) 55 (16.5)
No 157 (41.2) 107 (28.1) 117 (30.7)
Work hours per day 0.0014
8 54 (45.4) 32 (26.9) 33 (27.7)
9–14 305 (51.1) 152 (25.5) 139 (23.3)
Access to lactation room 0.3043
Independent space 299 (49.2) 157 (25.8) 152 (25.0)
No independent space 60 (56.1) 27 (25.2) 152 (25.0)
Breastfeeding knowledge 0.0210
Sufficient 189 (49.2) 88 (22.9) 107 (27.9)
Insufficient 170 (51.4) 96 (29.0) 65 (19.6)
Awareness of breast pumping breaks < 0.0001
Yes 240 (44.9) 150 (28.1) 144 (27.0)
No 28 (15.4)
Using breast pumping breaks 119 (65.8) 34 (18.8) < 0.0001
Yes 17 (6.6) 114 (44.0) 128 (49.4)
No 342 (75.0) 70 (15.4) 44 (9.6)

Table 3. Association Between Intention to Continue Breastfeeding and Predictors Among Employed
Mothers by Multiple Logistic Regression

Continue to breastfeed after returning to work

Between 1 and 6 months After 6 months

Variable OR (95% CI) p value OR (95% CI) p value

Age (< 30 vs. ‡ 30 years) 1.63 (0.95–2.85) 0.0828 0.91 (0.43–1.95) 0.8250
Education (‡ College vs. £ High school) 1.33 (0.74–2.40) 0.3313 2.66 (1.24–5.71) 0.0119
Husband’s education (‡ College vs. £ High school) 1.07 (0.59–1.97) 0.8083 0.72 (0.34–1.51) 0.3980
Worksite (Clean room vs. Office) 0.98 (0.55–1.76) 0.9694 0.65 (0.32–1.31) 0.2370
Shift work (Yes vs. No) 0.66 (0.35–1.21) 0.1832 0.70 (0.34–1.45) 0.3475
Work hours per day (£ 8 vs. 9–14) 1.45 (0.65–3.06) 0.3775 2.66 (1.16–6.11) 0.0206
Access to lactation room (Independent space vs. 1.17 (0.51–2.75) 0.7049 2.38 (1.14–6.32) 0.0284
No independent space)
Breastfeeding knowledge (Sufficient vs. Insufficient) 0.64 (0.38–1.02) 0.0667 0.81 (0.45–1.46) 0.5014
Awareness of breast pumping breaks (Yes vs. No) 1.09 (0.62–1.95) 0.7498 0.87 (0.43–1.73) 0.6921
Using breast pumping breaks (Yes vs. No) 33.1 (18.0–64.1) < 0.0001 61.6 (31.2–121.6) < 0.0001
Colleagues encourage breast pumping breaks (Yes vs. No) 2.53 (1.21–5.32) 0.0133 2.78 (1.14–6.76) 0.0235
Supervisor encourages breast pumping breaks (Yes vs. No) 2.45 (1.17–5.05) 0.0156 2.44 (1.06–5.61) 0.0355
Environmental health nurses encourage breast pumping 1.79 (0.88–3.62) 0.1060 1.74 (0.76–3.95) 0.1861
breaks (Yes vs. No)

CI, confidence interval; OR, odds ratio.

214
correlated with continued breastfeeding behavior after re-
turning to work ( p < 0.05), except for access to a lactation room
( p = 0.3043). Young age, lower education, clean-room work,
shift work, long work hours, lack of awareness or use of breast
pumping breaks, and self-reported insufficient breastfeeding
knowledge were all associated with discontinuing breast-
feeding after returning to work.
The results of the logistic regression analysis evaluating
independent predictors of continuing to breastfeed after re-
turning to work during the first 6 months and continuing to
breastfeed for more than 6 months are shown in Table 3.
Working mothers who did not breastfeed at the begin-
ning or breastfed for less than 1 month were treated as the
reference group. To determine independent variables and
intention to continue breastfeeding after returning to work for
the first 6 months, taking advantage of breast pumping breaks
(odds ratio [OR] = 33.1), and encouragement by colleagues
(OR = 2.53) or supervisors (OR = 2.45) to take breast pumping
breaks were significant predictors of continued breastfeeding
during the first 6 months after returning to work. For con-
tinuing breastfeeding for more than 6 months, a higher edu-
cation level (OR = 2.66), lower work lead (8 work hours/day;
OR = 2.66), lactation room with dedicated space (OR = 2.38),
taking breast pumping breaks (OR = 61.6), and encourage-
ment by colleagues (OR = 2.78) or supervisors (OR = 2.44) to
take advantage of breast pumping breaks were significant
predictors of intention to continue to breastfeed for more than
6 months after returning to work.
Discussion
The results of the present study revealed that the rate of
breastfeeding among employed mothers rapidly decreases
after returning to the workplace. Although 88.8% (635
subjects) initiated breastfeeding at the beginning of ma-
ternity leave, the continuing breastfeeding rate rapidly
decreased after returning to work (356 subjects [49.8%]
continued to breastfeed for at least 1 month after returning
to work). Almost 39% (635 – 356 = 279) of working mothers
discontinued breastfeeding within 1 month of returning to
work. Only 7.6% of these women continued to breastfeed
for more than 1 year, even if lactation rooms were avail-
able. A previous population-based cohort study in Taiwan3
reported that the overall prevalence of initial breastfeeding
was 83.7%. Overall, 67.9%, 39.4%, 25.4%, and 12.7% of
mothers who started breastfeeding still breastfed their in-
fants at the age of 1, 3, 6, and 12 months, respectively. The
prevalence rate of breastfeeding has been declining, and
employment is a persistent barrier to continued breast-
feeding. A study in the United States13 investigated the
effect of maternity leave length and time of first return to
work on breastfeeding, and, compared with those return-
ing to work within 1–6 weeks, women who had not yet
returned to work were more likely to initiate breastfeed-
ing, to continue breastfeeding beyond 6 months, and to
breastfeed beyond 3 months. A delay in returning to work
might increase the duration of breastfeeding. In Taiwan,
most companies provide only 8 weeks of paid maternity
leave. Juggling breastfeeding and paid work can be a
challenge to breastfeeding success. One study14 explicitly
demonstrated that a maternity leave of 6 weeks or less or
lasting 6–12 weeks after delivery was associated, respec-
TSAI
tively, with fourfold and twofold higher odds of failure to
establish breastfeeding and an increased probability of
cessation after successful establishment, relative to women
not returning to work, after adjusting for covariates. The
impact of a short postpartum leave on breastfeeding ces-
sation was stronger among non-managers, women with
inflexible jobs, and those with high psychosocial distress.
To achieve the World Health Organization’s recommen-
dation of 6 months of exclusive breastfeeding, working
mothers need a more supportive policy and an environ-
ment that protect and promote breastfeeding. Employers
play a critical role in mothers’ success with breastfeeding
when the women work full-time. The government could
consider extending the maternity leave and encouraging
employers to advocate for an extended paid postpartum
leave and greater flexibility in the working conditions for
breastfeeding women.
In our study, women had a low intention to breastfeed, and
the reasons included lack of time to breastfeed due to long
work hours, and difficulty breastfeeding due to clean-room
and shift work. In the workplace in this study, the working
mother often worked more than the legally mandated 8 hours
(83.3%), and 46.7% needed to take shifts and thus bear a heavy
work burden. Our data revealed that working mothers with
shift work had lower prevalence to use the breast pumping
breaks than non-shift workers (27.2% vs. 44.0%, p < 0.0001). In
addition, most working mothers (44.8%) worked in the clean
room. Our data revealed that 74.7% of the working mothers
understand the company policy providing two breast
pumping breaks per day, and there was no difference be-
tween clean-room and office-worksite working mothers
(72.1% vs. 77.6, p = 0.0911 [data not shown]). We found that
mothers working in the clean room had more difficulties us-
ing the breast pumping breaks than those at the office work-
site (24.3% vs. 43.6%, p < 0.0001 [data not shown]), implying
that an inconvenient working environment is an important
barrier to breastfeeding among working mothers. Similar re-
sults were demonstrated with working mothers at a semi-
conductor manufacturer and fabrication workers who needed
time to take off and put on their clean-room suit.11 A longi-
tudinal study15 evaluating work status on duration of
breastfeeding showed that working full-time at 3 months
postpartum decreases the breastfeeding duration, but work-
ing part-time does not reduce the initiation or duration,
whereas working part-time for more than 4 hours per day
decreases duration to a lesser extent than does working full-
time. Thus, the more hours the mother works, the fewer times
per day her infant receives breastmilk (including expressed
milk). In addition, to facilitating breastfeeding, the reduction
in work hours does not have to be large; this study found a
positive effect, relative to full-time work, when part-time
work was defined as less than 35 hours per week, or a maxi-
mum of 7 hours/day.
In our study, we found an association between a high level
of education and continued breastfeeding. One study16 that
explored breastfeeding intention of female physicians sug-
gested that mothers’ education may influence their breast-
feeding duration and found that their intentions and
knowledge correlated with their breastfeeding initiation
practices. Women employed as professionals breastfeed lon-
ger than other working mothers.17,18 In our study, it is pos-
sible that white-collar working mothers have more control
BREASTFEEDING-FRIENDLY WORKPLACE AND BREASTFEEDING
over their environment and schedules and are able to combine
breastfeeding and working more successfully than blue-collar
working mothers.
This study found that a breastfeeding-friendly breast
pumping break policy in the workplace significantly in-
creased continued breastfeeding behavior after returning to
work. In particular, encouragement to use breast pumping
breaks from working mothers’ colleagues and supervisors can
significantly affect their intention to continue breastfeeding
after returning to work. Moreover, lactation rooms with a
dedicated space increased the willingness to continue to
breastfeed. Hence, managers’ attitude and support influence
female employees’ perception of workplace breastfeeding
support. Previous studies indicated8,19 that managers influ-
ence the work climate of breastfeeding support by either
adhering to or ignoring company policies, informally sup-
porting or discouraging breastfeeding employees, or manag-
ing or disregarding issues arising among their coworkers. In a
breastfeeding-friendly workplace, the provision of lactation
rooms is a critical element and should include a private and
comfortable room at the worksite. Regarding lactation rooms
with dedicated spaces in our data, however, 51.3% of the
subjects used them, but there was only a 30% satisfaction re-
garding the lactation room (data not shown). The breast-
feeding rooms in the plants do not seem to be ideal in terms of
cleanliness and comfort. Regarding breastfeeding rooms
without dedicated spaces, most participants believe that there
should be breastfeeding rooms with dedicated space for em-
ployee use; 28% of the participants expressed this need (data
not shown). Past studies20,21 surveying employers’ attitudes
about breastfeeding-friendly support indicated that em-
ployers would be willing to help women who wished to
breastfeed or express milk in the workplace. These employers,
however, also stated that they saw little value to their business
of supporting breastfeeding in the work environment; even
when they were aware of the benefit of breastfeeding for the
mother, infant, and employers, they did not place a high
priority on providing breastfeeding support. In our study,
98.3% of working mothers were aware of the availability of a
lactation room, but only 36.2% took advantage of the two
breast pumping break policy. Perhaps it is not enough for
employers to provide space (dedicated lactation room); em-
ployers should also have a positive attitude toward their
pregnant employee. A previous study in England22 reported
that employers should do more to support breastfeeding, in-
cluding providing pregnant staff with information about
breastfeeding support that they should expect and could
therefore plan to use, including access to facilities to ex-
press and store breastmilk, to enable them to work flexible
hours, and to take rest breaks during working hours. Health
plans and employers may be able to promote breastfeeding by
providing breastfeeding education and support.23
Findings of another study7 indicated that the most signifi-
cant problem encountered by the breastfeeding mother is the
lack of an adequate facility in which to pump. In our study,
working mothers pumped in a public health center room
without dedicated space, only curtain separators. We com-
pared different breastfeeding rooms on the intention to con-
tinue breastfeeding (data not shown) and found that working
mothers with access to lactation rooms with dedicated space
had a higher awareness of the breastfeeding-friendly policy of
breast pumping breaks (79.3% vs. 48.5%, p < 0.0001), had more
215
encouragement to use the breastfeeding-friendly policy of
breast pumping breaks from their colleagues (78.5% vs.
66.4%, p = 0.0045), supervisors (61.0% vs. 50.5%, p = 0.0382),
and environmental health nurses (68.8% vs. 54.2%, p = 0.0075),
and were more likely agree that a breastfeeding-friendly
policy of breast pumping breaks helps working mother con-
tinue to breastfeed (93.4% vs. 81.3%, p < 0.0001). Working
mothers with access to lactation rooms without dedicated
space felt embarrassed to use breast pumping breaks (42.9%
vs. 30.5%, p = 0.014).
A breastfeeding environment without dedicated space
leads to earlier cessation of breastfeeding. Our data suggest
that employers should establish lactation rooms with a ded-
icated space so that they can be used by mothers who return to
work after giving birth to increase the rate of continued
breastfeeding.
Conclusions
There are some limitations to our study. First, this study
was cross-sectional in design; therefore, only association
could be evaluated, not causation. Second, assessment of
predictors adopted a dichotomized classification, which was
simplistic, and predictor measurements mainly relied on self-
report, which might have biased the results. Third, a selection
bias due to non-response was inevitable. Nevertheless, higher
education, lower work load, lactation room with independent
space, taking advantage of breast pumping breaks, and en-
couragement by colleagues and supervisors to use breast
pumping breaks were significant predictors of continuing to
breastfeed for more than 6 months after returning to work.
The findings of this study suggested that workplaces that
have established dedicated breastfeeding rooms should
maintain a comfortable and clean environment, so that they
can truly be a breastfeeding-friendly workplace environment,
enhance the frequency of usage of lactation rooms, and in-
crease the rate of continued breastfeeding.
Acknowledgments
This study was supported by grant NSC 100-2629-B-214 - 001
from the National Science Council, Taiwan.
Disclosure Statement
No competing financial interests exist.
References
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Address correspondence to:
Su-Ying Tsai, PhD
Department of Health Management
I-Shou University
No. 8, Yida Road
Yanchao Township
Kaohsiung County 824
Taiwan, Republic of China
E-mail: sytsai@isu.edu.tw